Medicare Physician Fee Schedule · Q4 2026 release
CPT 49505 in New York City, NY
13202-01
Status A
Medicare calculates a national payment amount for this code and pays it separately when the service is covered.
Full definition →
16.9% above the national baseline ($508.03)
( Work7.76 × 1.064 + Practice exp.5.40 × 1.162 + Malpractice2.05 × 1.586 ) × Conv. factor$33.4009 = $593.96
F Work RVU
7.76
G Non‑facility PE RVU
5.40
K MP RVU
2.05
Z Conversion factor
33.4009
E Work GPCI
1.064
F PE GPCI
1.162
G MP GPCI
1.586
CMS RVU26DOctober 1 – December 31, 2026revision 2
- Code
- 49505
- DOS
- Not selected; uses this release’s rates
- Locality
- MANHATTAN (NY)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q4 2026, revision 2
- Sequestration
- Shown separately from the allowed amount
Citations
Every input comes from a published CMS file. Open the same file at the row shown and the values match.
-
49505’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 5,827 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 49505
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 7.76
- G Non-facility PE RVU
- 5.40
- K MP RVU
- 2.05
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 5,825–5,829 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 13202-01’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 78 in rvu26d-updated-08-26-2026.zip
- A MAC
- 13202
- C Locality number
- 01
- E Work GPCI
- 1.064
- F PE GPCI
- 1.162
- G MP GPCI
- 1.586
In the CMS file
Loading rows 76–80 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
The Medicare allowed amount is $593.96 in the Office (non-facility) and Facility settings, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.
Q4 2026 · Locality 13202-01 · Participating · Whole service · Sequestration excluded
What Medicare locality is New York City, NY in? Copy link
New York City, NY is in CMS payment locality Manhattan (13202-01). The same amount applies everywhere in it.
Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.
ZIP codes in this payment locality (165)
The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.
65 more ZIP codes map to this locality. The New York City, NY locality page lists the full set.
Which ZIP codes does the New York City, NY rate for 49505 cover?
The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality, and 49505 has the same amount in every one of them. Examples include 10001, 10002, 10003, 10004, 10005, 10006.
How locality affects the amount Copy link
Office (non-facility) · Q4 2026 · Participating · Whole service
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put New York City, NY 16.9% above the national baseline.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See citations
Why is the 49505 rate in New York City, NY different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices—work 1.064, practice expense 1.162, malpractice 1.586—scale each RVU component before the conversion factor is applied, which is why the New York City, NY amount is higher than the $508.03 baseline.
Formula and inputs Copy link
For the office (non-facility) amount, each of 49505's RVU components is multiplied by its New York City, NY GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 49505
- DOS
- Not selected; uses this release’s rates
- Locality
- MANHATTAN (NY)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q4 2026, revision 2
- Sequestration
- Shown separately from the allowed amount
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 7.76 | × 1.064 | 8.2566 |
| Practice expense · Office (non-facility) | 5.40 | × 1.162 | 6.2748 |
| Malpractice | 2.05 | × 1.586 | 3.2513 |
| Sum of adjusted RVUs | 17.7827 | ||
| × 33.4009 conversion factor = formula amount | $593.96 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
-
Locality-adjusted allowed amount $593.96
After applicable fee-schedule adjustments; sequestration excluded
Citations
Every input comes from a published CMS file. Open the same file at the row shown and the values match.
-
49505’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 5,827 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 49505
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 7.76
- G Non-facility PE RVU
- 5.40
- K MP RVU
- 2.05
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 5,825–5,829 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 13202-01’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 78 in rvu26d-updated-08-26-2026.zip
- A MAC
- 13202
- C Locality number
- 01
- E Work GPCI
- 1.064
- F PE GPCI
- 1.162
- G MP GPCI
- 1.586
In the CMS file
Loading rows 76–80 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
CMS RVU26DOctober 1 – December 31, 2026revision 2
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in New York City, NY. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $593.96 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $564.26 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $648.90 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $475.17 |
| Patient coinsurance The remaining 20%. | $118.79 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $9.50 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $465.67 |
What is the non-participating amount and limiting charge for 49505 in New York City, NY?
A non-participating provider is paid $564.26—95% of the $593.96 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $648.90, which is 115% of the non-participating amount.
How much of the New York City, NY 49505 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($475.17) once the annual Part B deductible is met, and the beneficiary owes 20% ($118.79). Sequestration reduces Medicare's share by about 2% ($9.50), leaving $465.67. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in New York City, NY Copy link
Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$593.96 in the office (non-facility) setting—not the $508.03 national baseline.
Opens the calculator set to New York City, NY and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.
Compare 49505 in nearby payment localities
Payment localities in the same region as New York City, NY, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 49505. Neighboring localities often differ.
| Metro | Allowed amount | vs. New York City, NY |
|---|---|---|
| Queens, NY | $587.71 | -1.1% |
| Long Island, NY | $617.39 | +3.9% |
| Northern New Jersey, NJ | $557.87 | -6.1% |
| Philadelphia, PA | $533.30 | -10.2% |
| Hartford, CT | $541.48 | -8.8% |
| Boston, MA | $546.11 | -8.1% |
Every payment locality nationwide is on the CPT 49505 rate map.
Other codes priced in New York City, NY Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 66984 Cataract Surgery | $521.72 | +12.8% |
| 27447 Knee Replacement | $1,341.54 | +15.7% |
| 66982 Complex Cataract Surgery With Lens Implant | $711.26 | +12.8% |
| 27130 Total Hip Arthroplasty | $1,345.07 | +15.8% |
| 29827 Arthroscopic Rotator Cuff Repair | $1,127.91 | +15.5% |
| 47562 Outpatient surgery | $738.71 | +16.9% |
| 64721 Open Carpal Tunnel Release | $558.98 | +15.8% |
| 29881 Outpatient surgery | $596.66 | +15.7% |
| 23472 Total Shoulder Arthroplasty | $1,502.05 | +15.5% |
| 58571 Outpatient surgery | $957.09 | +15.5% |
| 19120 Outpatient surgery | $667.66 | +16.5% |
| 43775 Outpatient surgery | $1,171.48 | +17.1% |
Source & method Copy link
Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 13202-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.
Working a claim with an earlier date of service? The calculator prices 49505 in New York City, NY against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.
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